Deep peels indications

We have seen above that there is no problem with performing a localized phenol peel at the same time as a surgical face-lift if the two treatments are aimed at different areas. When both treatments are indicated for the whole face, the face-lift should be done first, followed by a rest period of around 6 months before the deep peel (Figure... 

Deep peels TCA (30%), salicylic acid (50%). These peels cause a deep frosting phenomena and they require home postpeeling management for the intense erythema. These peels are used in medium and deep acne scars. Ice-pick and boxcar scars can be treated with TCA 30% application all over the face when they are diffuse. When they are isolated, TCA cross 50-90% using cotton tips is the gold standard [15] (Fig. 13.13a. b). In Table 13.5, we sununarize the principal chenucal peels and their indication in acne. 

Figure 6.10 The picker. (A, B) Note the blanching with step I where the client had picked with the finger nail. The peel was completed with step IV. II and III were deleted. The skin was still blanched after 10 minutes, indicating a deep peel (C, D). An excellent peel at three days (E, F)...

The usual classification of chemical peels comprises superficial, medium and deep peels. For superficial peels, AHA, Jessner s solution, tretinoin, TCA in concentrations of 10-30% and most recently hpo-hydroxy add are used to induce an exfoliation of the epidermis. Medium-depth agents such as TCA (30-50%) cause an epidermal to papillary dermal peel with subsequent regeneration. Deep peels using TCA (>50%) or phenol-based formulations penetrate the reticular dermis to induce dermal regeneration. The success of peeling in darker skin is crudally dependent on the physician s understanding of the chemical and biological processes, as well as of indications, clinical effectiveness and side effects of the procedure (see Box 9.1). 

Figure 15.9 Patients carry their history on their skin. In this case hypopigmentation resulting from cryotherapy for actinic keratoses will give both the patient and the physician a pretty good indication of what might happen following a deep peel...

The main indications for deep chemical peel include dyschromia, wrinkles, premalignant skin tumors, and acne scars. 

Batteries are typically produced with deep drawn metal cans on which a pressure sensitive adhesive label is applied for product identification, branding and safety information. Customers began complaining of batteries becoming jammed in various types of equipment. Devices returned to the manufacturer showed that the pressure sensitive labels had peeled back, resulting in adhesion between the overturned label and the device. Further examination of batteries on store shelves for more than a year also indicated peeling labels in a low frequency of batteries. These labels consisted of laminates of paper and polyester. The labels are normally flat and stiff and when applied over a battery, the labels will return to the flat condition if the adhesive fails. This results in peel-back at the edges of the label. 

Deep wrinkles and folds are not a good indication for TCA peels ... 

With regard to acne, in 80% of cases, the first application of ETCA to active papulopustular facial lesions improves their number and severity by 50%, and the lesions seem to heal without scarring. ETCA is applied on the basis of one peel per week for 4 weeks that clear the lesions almost completely without having to resort to antibiotics. Deep wrinkles and acne scars do not disappear they lie deep under the skin and even phenol or carbon dioxide laser resurfacing cannot always treat them. A combination of several different techniques is clearly needed in these indications. 

The main indications for a TCA to the papillary dermis are the following photoaging, non-active acne, hyperpigmentation, melasma, chloasma, keratoses and fine lines. Unideep can also get rid of most freckles (Figure 23.2). A single peel is usually enough to achieve deep regeneration of the skin, but it may sometimes be necessary to repeat the peel for perfect results. 

A phenol peel is mainly indicated to treat facial skin for severe photoaging. It is the only type of peel that can get rid of deep wrinkles and regenerate elasticity and firmness in... 

These can respond very well to a phenol peel (Figure 30.2). Deep cheek wrinkles (Figure 30.3) caused purely by sun damage are one of the best indications for a phenol peel. 

These usually result from excessive skin laxity. Deep folds and furrows are not a good indication for phenol. They result from intrinsic aging and can sometimes be filled before a phenol peel. There is no need for a long time interval between... 

Using peels to different depths on the same patient is indicated when disorders of different depths coexist. Consider a patient who presents with early elastosis, a few lentigines and deep wrinkles on the upper lip only phenol can get rid of the wrinkles on the upper lip, but it would be unnecessarily deep to treat the early elastosis on the rest of the face. The phenol would of course get rid of the few senile lentigines, but a deep and very localized treatment with Only Touch can also get rid of them and with less risk. This patient would therefore benefit from the following combination (Figure 38.2) ... 

A number of small studies have indicated that the amelioration of more severe acne scars, moderately deep rhytides, and the effects of photoaging, which are often recalcitrant to standard treatment regimens, can be improved by combining microdermabrasion and super-hcial chemical peels in one treatment session. While more published data to support the use of this combined technique would be welcome, the data that are available indicate that it is highly effective, well tolerated, and more convenient for patients. 

Phenol peels have in the past been primarily indicated for deep rhytides in older, fair-skinned individuals because of the risk for hypopigmentation. Although any... 

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